Pregnancy in women with congenital heart disease

摘要

Advances in cardiac surgical and postoperative care have resulted in a growing cohort of adult survivors with congenital heart disease, including women of child-bearing age. It has been estimated that 1% of pregnant women sufferrfrom heart-disease, with congenital malformations being the most prevalent form and the leading nonobstetric cause of maternal peripartum morbidity and mortality. We first review physiological cardiovascular changes occurring during pregnancy. An evaluation of both maternal and fetal risks is then presented, with particular attention to prepregnancy counselling. Management issues regarding pregnancy and delivery are elaborated. Finally, selected subtypes of congenital heart disease are detailed at greater length. A knowledgeable multidisciplinary approach for evaluation, counselling and management of these patients is mandatory in order to optimize maternal and neonatal outcomes.